Dispelling nutrition myths, ranting, and occasionally, raving

Tag Archives: obesity

A couple of weeks ago I was listening to an episode of Radiolab on which they shared an episode of the short podcast series Unerased titled: Dr Davison and the Gay Cure. They were talking about the former perception of homosexuality as a disorder and the rise of conversion therapy. As I was listening what they were saying really struck a chord with me. I found myself thinking “this is exactly how people are going to think about weight loss counselling one day”.

On the podcast, they were saying, essentially, it doesn’t matter if people come to us wanting to change. What does it actually mean to help them? “The problem that these people are asking us to solve is a problem we created. That we labeled as a problem.” Even if we could effect certain changes, there is the more important question as to whether we should… It makes no difference how successful the treatment is, it is immoral.” And I was like “YES, this exact same thing could be said about weight loss treatment!”

This belief in relation to homosexuality was considered to be fringe and most people weren’t in support of it initially. This parallels the Health at Every Size/body diversity/weight acceptance movement. There is a lot of push-back from people in the medical community and the general public when it’s suggested that weight is not a condition that needs to be treated. Just as with the acceptance of homosexuality as a normal state, there were a few outspoken pioneers leading the movement and with time, it became more accepted by the mainstream. I feel that this is beginning to happen now with weight. More of us RDs who were always taught that “overweight” and “obesity” are unhealthy are coming to realize that people can be healthy at many different sizes.

Of course, there are still hold-outs and there is still conversion therapy happening in some places. Similarly, there will likely continue to be hold-outs who believe that only thin people can be healthy and that BMI is indicative of health. However, I’m hopeful that we’re reaching a turning point and that one day the medical community will agree that weight is not a “problem” and that weight loss treatments are unethical.

You would think that I wouldn’t have anything left to say about chocolate milk by now. I wish that you were right. I would have thought that I wouldn’t either until I read this article the other day about the school nutrition policy in New Brunswick and the current provincial election there. This uninformed inane quote from the leader of the PC party got me all riled up again:

“Brian Gallant is focused on taking chocolate milk away from our kids,” Higgs said in a press release. “I’d rather accomplish the same thing by giving our kids better access to organized sports activities and the character-building experience that come from participating in activities with peers.”

Higgs said in a press release that his government would scrap the nutrition policy entirely because, despite the importance of educating children about good nutrition, “we think helping them participate in activities with their peers is the goal – not legislating what’s on the menu.”

This is the sort of thing that makes me want to tear out my hair. It shows a complete lack of understanding of the issue at hand and sends the entirely wrong message to the public.

The first quote implies that 1. the issue at hand is obesity and 2. that we can compensate for whatever we eat through exercise. These are both patent falsehoods.

To address the first issue: the purpose of school nutrition policies is not to address childhood obesity. The purpose of school nutrition policies is to ensure that children are being provided with nutritious food when they’re at school. Schools should not be making money at the direct cost of the health of their students. In some cases, the only nutritious food that children receive may be when they’re at school. This has nothing to do with weight and everything to do with health, growth, and development.

To address the second issue: as much as we may all wish that it’s true, no amount of exercise can compensate for an unhealthy diet. Playing soccer is not somehow going to miraculously provide a child with vitamins and minerals and essential nutrients that are lacking from their diet. That’s just not how it works. As I’ve mentioned before, healthy eating and physical activity are not two sides of one coin, they are both essential components of a healthy lifestyle.

The message that the would-be premier is sending here is the widespread misconception that health is measured by the scale and that we can make-up for an unhealthy diet by exercising more. This is just not true.

Finally, to address the second quote: we know that education (insofar as that means telling people what to eat, giving them a copy of Canada’s Food Guide, and lecturing them about calories) doesn’t work. However, creating a supportive nutrition environment in which healthy eating is the norm, along with teaching food literacy, can teach children life-long healthy eating habits.

I completed an online course on weight bias and stigma for healthcare professionals last week. There was quite a bit that was good but there were a couple of things that rubbed me the wrong way.

If you’re not already aware Obesity Canada states that, “weight bias refers to negative attitudesand views about obesity and about people with obesity. Weight stigma refers to social stereotypes and misconceptions about obesity. These social stereotypes and misconceptions include beliefs that people with obesity are lazy, awkward, sloppy, non-compliant, unintelligent, unsuccessful and lacking self-discipline or self-control.”

Weight bias and stigma can cause significant harm to fat people. In fact, they likely cause more damage to people than carrying extra weight itself does.

The course I took was very good about making this clear and provided the facts as well as showing how harmful weight bias can be to patients. However, there was a video with some experts that I felt undermined the message. Here are the quotes that bothered me:

“If weight loss was easy we wouldn’t have the current obesity epidemic that we have.” – Director of Research and Anti-Stigma Initiatives at the Yale Rudd Center

“People think that for someone who’s overweight all they need to lose weight is some self-control and trying harder to eat less and exercise more. If that only worked we wouldn’t have the problem that we have today. The causes of obesity are very complex…” – Director of Research and School Programs at the Yale Rudd Center

The Yale Rudd Center is well-regarded for their work in reducing weight stigma and both of these individuals quoted above are prominent in the field. At first glance what they’ve said seems innocuous. However, the fact that this was a course intended to combat weight stigma, the experts are saying that obesity is an “epidemic” and a “problem” runs counter to the message they’re trying to convey. It just goes to show how deeply ingrained weight bias is when the very experts trying to counter it are inadvertently perpetuating it. When you say that obesity is a problem then you are saying that fat people are a problem. And I don’t see how that’s not stigmatizing.

The other problem I had with the course were the case scenario videos they shared. There would be one video where staff and medical professionals were rude and unprofessional to patients regarding their weight. Then they would show a video that was intended to show a positive interaction. Really the only differences in the “good” videos were that the healthcare professional was all smiles and asked the patient if they could talk about their weight before advising behaviour change under the guise of promoting healthy behaviours rather than telling them directly to lose weight. To me, the message was the same, it was “you need to lose weight” delivered with a smile rather than scorn. There was still no looking at overall health to determine if weight loss was actually warranted, there was still no consideration of other causes of the presenting ailments, and there was still no recognition that simply telling people to eat healthier and move more (especially without first determining what their current lifestyle is like) is not an effective way to get people to lose weight.

Overall, I felt that the message of the importance of not perpetuating weight bias was lost when all the healthcare professionals were still delivering the message to their patients that they should lose weight. And yes, some people can benefit from losing some weight, but this should be determined with appropriate assessment and then weight management options need to be appropriately discussed with the patient. Simply telling someone, on the basis of their BMI, to eat less and move more with a smile is not helpful.

If you do happen to know of a good online weight bias course please let me know as I’m still looking!

In relation to my recent posts about how a dietitian’s weight is not indicative of their professional capability, I’ve been thinking a lot about weight bias. Specifically, I’ve been thinking about how we portray (or don’t portray, as the case may be) people who are considered to be overweight or obese.

At work, I often find myself advocating for more diversity in our images of people. But by that I always mean “maybe we should include images of some people who aren’t young and white”. It actually kind of blows my mind that every time a draft comes back from a graphic designer that EVERYONE is youthful and white. Anyway… That’s not what I wanted to write about today. It’s the fact that they are also ALWAYS thin. I get it, we’re in the business of promoting health and what would you picture if I asked you to picture someone healthy. You’d probably envision someone who’s trim, youthful, smiling. The fact of the matter is though that health comes in all shapes and sizes.

Representation matters. If you don’t see yourself in an organization’s images, or a magazine’s, or in the media, you’re not likely to relate to the messages they’re sharing. I’m not talking about showing pictures of headless obese bodies when we’re talking about obesity, as a matter of fact, I’d rather we all just stopped talking about obesity altogether but that’s another rant. I’m talking about when we choose an image for a campaign for oral health, or a social media post about sexual health, or a banner promoting your services. Whatever the case may be. Think about it, with more than half the population falling into the category of overweight, our healthy living (and really ALL promotional) messages are missing out on a huge proportion of the population. If we truly want to promote healthy lifestyles for all then we need to include everyone in our messages. Don’t make it about weight though. Weight loss should not be the message. The message should be that everyone, regardless of size, age, ability, or race is deserving of good health and can enjoy a healthy active lifestyle. That everyone is deserving of health care services. That regardless of size, your voice should be heard. It really stuck with me how in Hunger, Roxanne Gay wrote about becoming more invisible the larger her body became. This is not how things should be. Your worth should not be inversely proportionate to your weight.

If you want to start including more positive non-stereotypical images of people with obesity in your work, check out Obesity Canada’s image bank or Yale Rudd Centre’s image gallery.

I feel the need to expand on something I touched on in my post last week. It’s related to people judging dietitians on the basis of our weight. My previous post mainly discussed why it’s inappropriate to judge anyone’s professional abilities, including dietitians, on the basis of their perceived size. However, I think this all too common judgement also speaks to the lack of understanding of what we do.

There’s a common (mis)perception that dietitians are all weight loss counsellors. As a result, if we don’t have that elusive “perfect body” people think that we suck at our jobs. After all, what else do we do other than police the food people put into their mouths. If we can’t control the food going into our own mouths, how on earth can we possibly control the food going into the mouths of all the other owners of “unruly” bodies. While some dietitians certainly do work in weight management, even those dietitians are not actually food police. The majority of dietitians don’t work in weight management. Curious what a dietitian actually does, check out this old post.

It is not part of my job to control my body so that it fits your perceived notion of healthy and fit. Whether or not I am large has no bearing on my knowledge of nutrition. It does not impede my ability to calculate a tube feed, modify a recipe, expound on celiac disease, or help someone with diabetes manage their blood sugar. Just as being small and having no knowledge of nutrition does not automatically imbue me with the capacity to do these things. As with any profession, the size of a dietitian is not a reflection of their knowledge, experience, or capability.

Dietitians do So Much More than help people lose weight. Despite the impression that our name gives, we are not all about putting people on diets. For many of us, aside from medically necessary diets (for example in the case of allergy sufferers or those with celiac disease) “diet” is a four letter word. We’re not all on a mission to rein in unruly bodies and create a world populated solely by thin bodies. When we do work in positions of counsel we usually aim to help people to gain greater compassion for, and appreciation of their own bodies. To help people view food as a source of pleasure rather than an enemy out to destroy our hard-fought-for chiselled physiques.